Lessons from a Pioneer in Global Health

Throughout my career in medicine, I have always had an interest in global health. As I approach retirement, I now have the time and resources to pursue medical missions in third-world countries. My first trip of many was this year, when I traveled with HELPS International, a nonprofit focused on providing healthcare services to third-world countries, to a remote Guatemalan highlands city of Tejutla. It was an eye-opening experience and increased my awareness on the amount of poverty in the world, as well as a lack of even basic healthcare services.

My next trip is planned to a different city in Guatemala for April of next year. I'm really looking forward to it now that I have one trip under my belt and know what to expect. I have been doing more reading about global health, and my editor at the American Academy of Physician Assistants (AAPA) suggested that I read a book about Paul Farmer, a pioneer physician and anthropologist in the world of global health initiatives

The book, "Mountains Beyond Mountains," by author Tracy Kidder is a biography of Farmer, who "A man who would cure the world." I really didn't know what to expect when I started reading this book this summer. The minute that I dove into the first page, I was hooked. This book is a well written and well researched story and analysis of how Farmer became synonymous with global health in the world.

Farmer came from an interesting family and was incredibly academically gifted. All it took was one trip to Haiti after he graduated from Duke with a degree in Anthropology. According to Kidder's book, he could not believe the infant and child mortality and the endless cycles of morbidity and mortality that were driven by the most appalling poverty anyone has ever seen, coupled with a complete lack of infrastructure. There was an absence of the most rudimentary things that we take for granted in the U.S.: clean water, sanitation, access to healthcare, etc.

Many gifted and caring physicians came, but they all left having not even made a microscopic dent in Haiti's  catastrophic healthcare situation. His training in anthropology was instrumental in his vision, and he immediately understood the fundamental problems, which was you have to meld "doctoring" with public health to make a lasting change for the good in the lives of this impoverished country.

He landed in Cagne, Haiti, and started his work establishing a project locally known Zanmi Lasante. Despite a complete lack of resources, money, and equipment, he would not be deterred.. What was amazing to me is that he started this mission, which has been replicated throughout the third world while he attended medical school at Harvard full time. Splitting his time between Harvard Medical School and Cagne, he worked tireless to grow his mission, using innovative techniques to empower the community to solve their own problems, while carefully and continuously building a medical infrastructure that was sustainable and appropriate for this community and country.

For instance, the first problem was HIV / AIDS. Farmer systematically and simultaneously tackled the problems of acquiring medications and setting up a system to dispense them, monitor compliance, and utilize indigenous public health workers.

The second problem was Multi-Drug Resistant (MDR) Tuberculosis (TB). At the time, there were a lot of failed treatments and the cost of the drugs needed to deal with MDR TB was considered to be prohibitive. Therefore, global health agencies took the tact of retreating failure patients with the same regimes, or with other ineffective regimes.  

Farmer was able to successfully lobby health agencies and convince them through self-funded successful treatment programs, the cost of effective treatment was much cheaper than the cost of failure. By setting up effective, community-based monitoring programs, staffed by community members, he was able to cure many cases of MDR TB in Peru, Haiti, and other countries as he replicated his experience.

His comprehensive approach to seemingly unsurmountable problems in global health can't be effectively discussed in this short blog. What he has to teach the world makes reading "Mountains Beyond Mountains" imperative for anyone interested in global health.

Here are a two major lessons I learned from this book:

1. You can't apply first world solutions to third-world health problems. Farmer was an innovator and visionary, who was able to take local resources, human and otherwise, infused with outside money from dedicated donors, and develop health systems that cured disease and improved all health status indicators in the communities in which he worked.

2. You can't look at global health problems in simple dollars and cents. He was able to put the potential, and real disaster posed by HIV/AIDS and MDR TB and its effect on the health status indicators in a community into terms that governmental leaders could understand, and mobilized effective, comprehensive responses to these problems.